It is an important landmark for women in the UK to have the evidence regarding HRT collated in the first NICE guideline on this topic. Unfortunately the US trial data from 20021,2 caused havoc with HRT prescribing in the UK, and left thousands of women stranded and suffering despite the concerns that the trials included US women commencing HRT at an average age of 65 years.

More recent randomised control trials3,4 and meta-analyses5 show that initiating HRT around the natural age of menopause does not increase cardiovascular risk, and indeed appears to be cardio-protective. It is these 45-55 year old women who suffer most with symptoms and for whom we most often prescribe HRT in the UK.

Important messages from the guidance concerning management of the perimenopause include: blood tests are not needed before initiating HRT; contraception is required in addition to standard HRT; and the consideration of combined hormonal contraception or Mirena with estrogen replacement as management options.

Dr Jenny Brotherston is a GPSI in sexual health, community gynaecology and menopause at the City Health Care Partnership in Hull